No abstract available.
Foot* ; Tarsal Bones*

PURPOSE: To determine the relation between clinical results and correction angle in proximal tibial osteotomy through the retrospective study. MATERIALS AND METHODS: Seventy-two valgus osteotomies of the tibia were performed in forty-nine patients from 1985 to 1992; average follow-up period was 7 year 11 months(range, 5 to 12 years). We classi- fied the patients into three groups according to the tibiofemoral angle measured at the last follow-up. Group I includes patients with less than valgus 6 degrees of tibiofemoral angle, Group II with from valgus 7 degrees to 9 degrees and Group III with more than valgus 10 degrees. RESULTS: The Insalls Hospital for Special Surgery knee score was gradually decreased in time as 95 at postoperative 2 years, 92 at 5 years and 82 at the last follow-up. The average preoperative tibiofemoral angle was varus 3.4 degrees and the average postoperative tibiofemoral angle was corrected as valgus 8.0 degrees, 7.9 degrees at two years, valgus 7.0 degrees at five years and valgus 5.4 degrees at the last follow-up. The group I, 40 cases(mean 9 year 7 month follow-up), showed postoperative valgus 6.4(3-15) degrees and val- gus 2.6 degrees at the last follow-up. Loss of correction was 3.8 degrees and knee score was 76 at the last fol- low-up. The group II, 21 cases(8 year 1 month), showed postoperative valgus 9.0(7-11) degrees and 7.6 degrees at the last follow-up. Loss of correction was 1.4 degrees and knee score was 83.5 at the last follow- up. The group III, 11 cases(7 year 7 month) showed postoperative valgus 11.4(10-15) degrees and 10.9 degrees at the last follow-up. Loss of correction was 0.5 degrees and knee score was 97 at the last follow-up. The group III showed better maintenance of postoperative correction angle and clinical results than the other gf OUpS. CONCLUSION: Deductively, it is essential to correct tibiofemoral angle more than 7, especially ranged from 10 to 15 degrees for the best long-term clinical results.
Follow-Up Studies ; Humans ; Knee ; Osteotomy* ; Retrospective Studies ; Tibia

PURPOSE: We evaluate the influence of the types of coffee beverage on obesity and abdominal obesity in Korean adults who were aged 19 years or over by using the 2013 ~ 2016 Korea National Health and Nutrition Examination Survey (KNHANES). METHODS: Specific questions were asked about frequency of coffee intake, the type of coffee beverage, the addition of milk and/or sugar to coffee by using the food frequency questionnaire of the 2013 ~ 2016 KNHANES. RESULTS: We found that coffee intake increased the prevalence of obesity and abdominal obesity. After multivariable adjustment, coffee consumption increased the risk of obesity by 1.30 (95% CI: 1.08 ~ 1.57) in the group that drank coffee twice a day, and 1.33 (95% CI: 1.11 ~ 1.60) in the people who drank coffee ≥3 times a day as compared to that of the non-coffee intake group. The risk of abdominal obesity increased to 1.27 (95% CI: 1.02 ~ 1.57) in the < 1 time/day coffee drinking group, 1.34 (95% CI: 1.08 ~ 1.66) in the 1 time/day coffee drinking group, 1.35 (95% CI: 1.09 ~ 1.67) in the 2 times/day coffee drinking group, and 1.40 (95% CI: 1.14 ~ 1.72) in the ≥ 3 times/day coffee drinking group as compared to that of the non-coffee drinking group. The influence of black coffee intake was different according to gender: males showed a high prevalence of abdominal obesity and females showed a high prevalence of obesity. Mixed coffee consumption increased the risk of obesity and abdominal obesity by more than 34% in men who consumed coffee more than 3 times a day and in women who consumed coffee more than 2 times per day. CONCLUSIONS: We found that coffee intake, regardless of the type of coffee, increased the prevalence of obesity and abdominal obesity. It is necessary to refrain from drinking coffee to prevent obesity.
Adult ; Beverages ; Coffee ; Drinking ; Female ; Humans ; Korea ; Male ; Milk ; Nutrition Surveys ; Obesity ; Obesity, Abdominal ; Prevalence

PURPOSE: This study was performed to compare the efficacy and adverse reactions of low dose intravenous immunoglobulin (IVIG) with those of high dose IVIG in childhood acute idiopathic thrombocytopenic purpura (ITP). METHODS: Thirty children who were diagnosed as acute ITP in Seoul National University Children's Hospital from June 2000 to Jan. 2003 were enrolled. IVIG (I.V Globulin S, Green Cross Ltd, Korea) were administered 1 g/kg in low dose group (n=15) and 2 g/kg (400 mg/kg for 5 day or 1 g/kg for 2 days) in high dose group (n=15). RESULTS: 1) The median age of the patients was 4 years (range, 2 months to 13 years) and male to female ratio was 0.5: 1. The median duration of follow-up was 6 months (range, 1 month to 2 year 9 months). 2) The median days to recover the platelet count over 50, 000/muL, 100, 000/muL, 150, 000/muL after IVIG administration were 4, 6, and 7 days in the low dose group and 3, 5, and 5 days in the high dose group. After the initial response, the platelet count decreased below 50, 000/muL in 5 out of 13 patients in the low dose group (the median day, 13) and 6 out of 13 patients in the high dose group (the median day, 21). In 25 patients who were followed over 6 months, 3 out of 13 patients (23.1%) in the low dose group and 4 out of 12 patients (33.3%) in the high dose group were remained as chronic ITP. 3) Adverse reactions related to IVIG administration were observed in 4 out of 15 patients (26.7%) in the low dose group and 5 out of 15 patients (33.3%) in the high dose group. They were fever, headache, nausea and vomiting, and most of them were subsided spontaneously. CONCLUSION: There were no significant difference in the response rate, the relapse rate and the incidence of adverse reactions between the low dose group and the high dose group in childhood acute ITP after IVIG therapy. In respect of the cost and the duration of hospitalization, the low dose IVIG might have some advantages.
Child ; Female ; Fever ; Follow-Up Studies ; Headache ; Hospitalization ; Humans ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Incidence ; Male ; Nausea ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic ; Recurrence ; Seoul ; Vomiting

BACKGROUND: The testes are one of the most common extramedullary sites of relapse in boys with acute lymphoblastic leukemia(ALL). The reported incidence of isolated testicular relapse varies from 3 to 40%. If these patients are treated exclusively with testicular irradialion, a systemic relapse occurs within a few months. Recently, the use of intensive chemotherapy and testicular irradiation improved the survival rate for boys with testicular leukemia. So, we performed this study to identify clinical manifestations, disease free survival and prognostic factors of testicular leukemia in children. METHODS: We reviewed 33 patients of testicular leukemia among total 410 boys with ALL diagnosed at the Department of Pediatrics, Seoul National University Children's Hospital from Jan. 1970 to Aug. 1996. Testicular leukemia was confirmed by testicular biopsy in all 33 patients. These patients were treated with combined local testicular irradiation(2,400~2,500 cGy/8~12fractions) and systemic chemotherapy. Two patients, in whom testicular relapse was diagnosed before 1979, unilateral orchiectomy of the involved site and testicular irradiation of the opposite site were performed. Probability estimates of disease free survival (DFS) were calculated by the method of Kaplan and Meier, and the relationship of prognostic factors to DFS was compared using the chi-square test in survival analysis. RESULTS: In 410 boys with ALL, testicular leukemia occurred in 33 patients(8%). Of 33 patients, 6 patients presented with testicular involvement at initial diagnosis, 16 patients had testicular relapse while still receiving chemotherapy and 11 patients had testicular relapse 3 to 57 months(median : 15 months) after cessation of chemotherapy. The median age of 33 patients was 7.4 yrs(9 months~18 yrs) and median WBC count 7,600/ L(2,700~270,000/L). All patients presented with painless testicular enlargement and testicular leukemia was confirmed by testicular biopsy. Among 33 patients, 2 had prior CNS relapse and 11 had concomitant bone marrow and/or CNS relapse. Twenty nine patients were treated with combined local testicular irradiation and systemic chemotherapy. Eleven had second relapse(6 bone marrow, 3 CNS, 2 opposite testis). Seventeen have been followed until now: 6 patients on chemotherapy and 11 patients(37.9%) in complete remission for 48.5+/-22.3 months(19~86 months). The 3 year DFS for 29 patients was 55.3%+/-10.1%. The following prognostic factors showed no significant association with DFS in testicular relapse : age and WBC count at initial diagnosis, age at testicular relapse, and concomitant relapse. Whether testicular relapse occurred on initial therapy or off initial therapy has prognostic value in predicting DFS. The 3 year DFS for boys with testicular relapse on and off initial therapy were 40.0%+/-12.9% and 78.8%+/-13.4%, respectively(P: 0.046). CONCLUSION: With the use of chemotherapy and testicular irradiation, prolonged second re mission can be achieved in many patients with testicular leukemia. The patients with testicular relapse off initial therapy fared significantly better than patients on therapy. So, to improve the DFS for boys with testicular leukemia, a better understanding of its biology and prognostic factors is needed.
Biology ; Biopsy ; Bone Marrow ; Child ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Humans ; Incidence ; Leukemia ; Missions and Missionaries ; Orchiectomy ; Pediatrics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Recurrence ; Seoul ; Survival Rate ; Testis

"Mirror-writing" is the simultaneous process of reversing individual letters and composing word strings in reverse direction. It is reported that the lesions which cause "mirror-writing" are left parietal lobe, left basal ganglia, right supplementary motor area, left supplementary motor area, left cingulate gyrus, and left angular gyrus. To explain this phenomenon, several theories have been proposed such as the motor, the visual dominance, the supplementary motor area, the visio-spatial, the visual word- form, the hemisaptial factor or directional and the reflected graphemic representation hypotheses. With reviewing some of literatures, we present a case of "mirror- writing" of posterior corpus callosum lesion which is not included in the aforementioned those.
Basal Ganglia ; Corpus Callosum* ; Functional Laterality ; Gyrus Cinguli ; Infarction, Posterior Cerebral Artery* ; Parietal Lobe ; Posterior Cerebral Artery*

The survival in cases with relapsed Wilms tumor is dismal. Recently, however the introduction of new therapeutic agents and experimental strategies has improved the survival. We analysed the survival of patients with relapsed Wilms tumor according to the treatment period. During the early period 1983-1993, patients who had received two drugs were treated with doxorubicin and the others were treated with cisplatin and etoposide, whereas during the late period 1994-2004, patients were treated with combinations of cyclophosphamide/etoposide and carboplatin/etoposide. During the early period, 8 of 57 experienced relapse, and 8 of 41 relapsed during the late period. Only 2 patients treated during the early period survived in complete response (CR), whereas during the late period, 5 patients remained alive in CR, and 3 of those received high-dose chemotherapy (HDC) with autologous peripheral stem cell rescue (SCR). The estimated 5 yr event-free survival rate was 37.5% in the entire study group, 50% for patients in the late period, and 25% for patients in the early period (p=0.38). The survival in patients with relapsed Wilms tumor dramatically improved during the late period and HDC with SCR was one of the effective salvage strategies.
Wilms Tumor/*mortality/*pathology ; Treatment Outcome ; Time Factors ; *Recurrence ; *Peripheral Blood Stem Cell Transplantation ; Male ; Korea ; Infant ; Humans ; Female ; Disease-Free Survival ; Child, Preschool ; Child ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use

A 13 year-old girl with osteosarcoma and pulmonary tumor recurrence developed acute renal failure following high dose methotrexate (12 g/m2) therapy, she had previously tolerated high dose methotrexate and her renal and hepatic functions were normal. Briefly, 48 hours after beginning methotrexate infusion her methotrexate concentration and creatinine level were 1338.8microM/L and 5.8 mg/dl, respectively. Grade IV oral mucositis and neutropenia with fever developed at 144 hours after MTX infusion. Hydration and alkalinization were continued and leucovorin rescue was intensified based on the plasma MTX concentrations. Plasma exchange was performed twice and hemodialysis 3 times without problems, but methotraxate and creatinine levels remained high, 91.9 microM/L, and 2.5 mg/dl, respectively. After 3 courses of hemodialysis carboxypeptidase-G2 (CPDG2) was administered at 50 U/kg, intravenously over 5 minutes. After 15 minutes of CPDG2 (Voraxaze(TM)) infusion, her plasma MTX concentration was 0.91microM/L and no rebound elevation or side effects developed. Thirteen days post-MTX infusion her renal function had normalized. We report here our experience of a dramatic methotrexate level reduction caused by CPDG2 administration.
Acute Kidney Injury ; Adolescent ; Creatinine ; Female ; Fever ; Humans ; Leucovorin ; Methotrexate ; Neutropenia ; Osteosarcoma ; Plasma ; Plasma Exchange ; Recurrence ; Renal Dialysis ; Stomatitis

PURPOSE: This study was performed to identify the etiologic agents and antimicrobial susceptibility patterns of organisms responsible for bloodstream infections in pediatric cancer patients for guidance in empiric antimicrobial therapy. METHODS: A 5-year retrospective study of pediatric hemato-oncologic patients with bacteremia in Seoul National University Children's Hospital, from 2006 to 2010 was conducted. RESULTS: A total of 246 pathogens were isolated, of which 63.4% (n=156) were gram-negative, bacteria 34.6% (n=85) were gram-positive bacteria, and 2.0% (n=5) were fungi. The most common pathogens were Klebsiella spp. (n=61, 24.8%) followed by Escherichia coli (n=31, 12.6%), coagulase-negative staphylococci (n=23, 9.3%), and Staphylococcus aureus (n=22, 8.9%). Resistance rates of gram-positive bacteria to penicillin, oxacillin, and vancomycin were 85.7%, 65.9%, and 9.5%, respectively. Resistance rates of gram-negative bacteria to cefotaxime, piperacillin/tazobactam, imipenem, gentamicin, and amikacin were 37.2%, 17.1%, 6.2%, 32.2%, and 13.7%, respectively. Overall fatality rate was 12.7%. Gram-negative bacteremia was more often associated with shock (48.4% vs. 11.9%, P<0.01) and had higher fatality rate than gram-positive bacteremia (12.1% vs. 3.0%, P=0.03). Neutropenic patients were more often associated with shock than non-neutropenic patients (39.6% vs. 22.0%, P=0.04). CONCLUSION: This study revealed that gram-negative bacteria were still dominant organisms of bloodstream infections in children with hemato-oncologic diseases, and patients with gram-negative bacteremia showed fatal course more frequently than those with gram-positive bacteremia.
Amikacin ; Bacteremia ; Bacteria ; Cefotaxime ; Child ; Escherichia coli ; Fever ; Fungi ; Gentamicins ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Imipenem ; Klebsiella ; Neutropenia ; Oxacillin ; Penicillins ; Retrospective Studies ; Shock ; Staphylococcus aureus ; Vancomycin

Renal cell carcinoma (RCC) is a malignancy arising from the tubular epithelial cell. RCC is a rare disease in children with an incidence of 0.1~0.3% of all childhood cancer. It is known that RCC in children is different from its adult counterpart in some aspects. Although conventional treatment of RCC is radical nephrectomy with lymph node dissection, we tried systemic treatment for advanced disease. Because metastasis is common at diagnosis and RCC is usually resistant to radiotherapy or chemotherapy, immunotherapy such as interferon-alpha (IFN-alpha) or interleukin-2 (IL-2) is investigated and clinically used. We have experienced 3 children with RCC and two with stage IV disease were treated with systemic immunotherapy. One who had stage IV, recurred RCC is followed-up for 16 months without the evidence of disease progression with IFN-alpha and IL-2. We report these 3 cases with a brief review of literatures.
Adult ; Carcinoma, Renal Cell* ; Child ; Diagnosis ; Disease Progression ; Drug Therapy ; Epithelial Cells ; Humans ; Immunotherapy* ; Incidence ; Interferon-alpha ; Interleukin-2 ; Lymph Node Excision ; Neoplasm Metastasis ; Nephrectomy ; Radiotherapy ; Rare Diseases